Portal Hypertension (cont.)

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

How is the diagnosis of portal hypertension made?

Portal hypertension usually is diagnosed well after the process has begun in
the body, and
only after a complication occurs. When a patient develop ascites or has
gastrointestinal bleeding, the health care professional will look for potential
causes, including portal hypertension.

Once the diagnosis is a possibility, it can be confirmed by blood tests,
X-rays, CT or MRI and endoscopy. Pressures within the portal vein are not
routinely measured except in specific situations (see TIPS procedure)

What is the treatment for portal hypertension?

Treatment for portal hypertension is often directed at preventing
complications. This includes treating the underlying cause and avoidance of alcohol.
Because of the risk of further liver damage, over-the-counter medications that
contain acetaminophen (Tylenol, Panadol,
etc.) should also be avoided.

Dietary restrictions include limiting salt to prevent further ascites fluid
accumulation. Protein restriction may also be indicated, since increased protein
load can overwhelm the liver's ability to synthesize it and may lead to hepatic
encephalopathy.

Medications such as beta blockers and nitroglycerin may be appropriate to
decrease pressure within the portal system. Lactulose may be prescribed as a
treatment for hepatic encephalopathy.

Endoscopy may be required to band or tie off varices in the esophagus to
prevent catastrophic and life threatening bleeding.

A TIPS procedure (transjugular intrahepatic portosystemic shunt) may be an
option to decrease the pressure within the portal system. An interventional
radiologist attempts to place a tube that connects the portal vein with the
hepatic vein. This may decrease the pressure within the liver and may also
reduce pressure within the veins of the stomach and esophagus, hopefully
decreasing the risk of bleeding.